Aren't patients more than their hair and bad skin?!

Why are so many of my physician colleagues shelving their expertise in favor of operating a glorified beauty salon?  Healthy Concerns recently interviewed a disgruntled doc who felt the "office aesthetic field" was his only recourse.  How sad.

At Know Your Bones, I'm examining our fractured health system.

According to Christian Raulin, M.D.; Baerbel Greve, M.D.; Sabine Raulin, M.D.:  "The massive public interest and the patient´s demand for laser treatment regardless of the indication have led many physicians to follow the booming trend and acquire a laser (2). In these days of tight budgets, it is implied that lasers provide powerful sources of additional income outside of the field of managed care."

The payors (insurance companies and the government) have trivialized your doctors' expertise in managing your vital organs--they've set the rates we'll be paid, and have reduced the practice of medicine to piecework. 

I wish that legitimate disease management and health promotion received as much fanfare as all this window dressing.  If you'd be willing to pay for hair plugs, Botox or thin thighs, what would you be willing to pay for sturdy joints, a vigorous heart and a tireless brain?  Please tell me, I'm interested...

Comments

[Bryan]

The question "how much would you pay for sturdy joints?" is an interesting one. I started to answer it but it's kinda pointless to ask it even rhetorically as sturdy joints can't be had at any price by someone who is arthrotic. So, I guess that people may as well invest their money into some aspect of themselves that actually has the potential for improvement. We both know that that arthrotic joint can't improve even if you treat it with the usual- physical therapy, vitamins and supplements, activity modification, rest, etc. It will just keep getting worse no matter what.

[Stephanie]

Oh, Bryan! Au contraire! Sturdy joints can be had by anyone capable of moving those joints to preserve the resilience of the stabilizing muscles and ligaments, and improve blood flow to the tissues. Granted, we don't yet have the magic wand that will reverse cartilage deterioration of OA (tho' there's lots of promising evidence about proper nutrition/supplements). The name of the game isn't to make the XRay look better, it's to help the patient move and feel better. However, if a hip, knee, ankle, shoulder, elbow, wrist, knuckle or spine is painful despite the treatments you mention, there are several reliable surgical options.

It breaks my heart to think that someone feels it's worthwhile painting over a rotting foundation (with botox, fake teeth or hair plugs), but not reconstructing that foundation to ensure independence, mobility and safety!

I hope you haven't been discuraged by your doctors with "there's nothing I can do." Until surgery, there ISN'T anything THEY can do. But there's lots YOU can do!

[Bryan]

Of course I've been discouraged that they've said there's nothing they can do. This is a serious and, worse, common problem and they're powerless to affect it.

What you would call "reliable" surgical options, I wouldn't. My understanding of prostheses is that they're very fragile and they impose enormous activity restrictions. Worse, they don't last long. If those are reliable, they are so only in that they are activity limiting and don't last long.

And then there's joint fusion. It will reliably immobilize a joint, which will probably have deterimental effects elsewhere in the kinetic chain; the motion not performed by one joint will require and akward motion by an adjacent joint.

I already know there's "lots" we can do. I made mention of it in my first post. I also know that we can't do anything to stop the disease- that much of what we do is in vain- and that we will never have normal, healthy cartilage which is relevant because our degenerating cartilage makes our joints so sensitive and painful that our career options and recreational options shrink. Gone for many of us are the jobs that we enjoyed and were happy to go to everyday. Now we're stuck doing sedentary jobs. Gone are our athletic pursuits- "don't do anything that makes heavy use of the effected joints".

I don't agree that one can "reconstruct the foundation". That's just the point. The foundation is rotting and there's nothing anyone anywhere can do about it.

I'm disappointed that you used the expression "magic wand". It is used often by callous orthopedists who are sick of people bringing them problems for which they have no solution.

[Bryan]

Allow me to somewhat revise my earlier post. I didn't mean to impliy that you, Dr. Siegrist, are callous. You seem quite the opposite; you seem to want to help arthritis sufferers.

My suggestion, though, is that you not use the "magic wand" expression, even though you don't use it with callousness. We patients aren't simpletons who want a magical solution to our problems. However it's not unreasonable for us to want a direct solution- not palliation, at best, but a direct solution- to a problem that immensely impacts our lives- our ability to function, financially support ourselves, and have recreational pursuits that we are passionate about.

I personally see the inability to halt chondrosis as THE failure of orthopedics as a branch of medicine. I'm glad, though, that there seems to be enough of an interest in this problem that it is being probed from several angles. It is somewhat reassuring that there are people in the medical community who appreciate how devastating chondrosis is and wish to try to find a way to stop it rather than apathetically accepting it as unstoppable and the suffering that it causes insignificant.

[Stephanie]

Please see my 8/9/05 post http://www.knowyourbones.com/2005/08/my_heart_goes_o.html . Thanks, Bryan. You've helped me appreciate a patient's perspective.